Intent to Enroll Form

Thank you for your registration.

The School of Continuing Education is accepting registrations through this form.

Submission does not guarantee registration.

We will confirm enrollment within the next few business days. Business days are Mondays through Fridays and excludes campus holidays and Winter Break.

You are welcome to reach us at askce@ngskmc-eis.net.

While Triton College is on winter break, the School of Continuing Education is accepting registrations.

Intention * I am Inquiring/Requesting Information I would like to Register

Refund Policy: One hundred percent refund up to 3 business days (9AM - 5PM) prior to the start of class. No refunds will be granted after this time. No-shows do NOT constitute cancellation.

NOTE: Times, dates and costs listed are subject to change. All tuition fees are subject to revision by the Triton College Board of Trustees without prior notice.

Refund Policy * I understand the Refund Policy

Purpose of this form * To prepare for a new or first career To improve present skills To explore courses to decide on a career To prepare for transfer to a four-year college To remedy basic skill deficiencies To pursue noncareer, personal interests, school diploma equivalence Other

Semester You Intend to Enroll * Fall Spring Summer

Year You intended to Enroll *

List Course You are Interested In *

Course Preferences (Select ANY which may Apply) AM Courses PM Courses Campus Courses Online Courses

Birthdate *

First Name *

Middle Name or Initial

Last Name *

Legal Sex * Male Female

Gender Identity Man Woman Trans-Man Trans-Woman Non-Binary Gender Nonconforming

Ethnicity * Hispanic/Latinx Non Hispanic/Latinx I Do Not Wish to Disclose

Race * (Select ALL which may Apply) American Indian/Alaska Native Asian Black or African American Hawaiian/Pacific Islander White Asian/Pacific Islander Unspecified/I Do Not Wish to Disclose

Are you in the United States on a Visa — Nonresident Alien? * (if yes, please provide Country of Origin Below) Yes in the United States on a Visa Not in the United States on a Visa

Country of Origin (if on a VISA)

Employment Status Employed full time Employed part time, more than 15 hours/week Employed part time, less than 15 hours/week Homemaker Unemployed Other/No response

Company Name (If Applicable)

Address *

Apartment/Unit

City *

State * Select a state Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip Code *

Contact Phone *

Alternate Phone

Email *

How did you hear about the program? * Website Flyers Radio/Television Social Media Other

Are you currently taking or have you in the past taken any course(s)/class(es) at Triton College? * Yes No

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